Inguinal Hernia Repair Surgery Research Articles

Complications while awaiting elective inguinal hernia repair in infants: Not as common as you thought

BackgroundThe dogma of early inguinal hernia repair in infants, especially those born prematurely, has dominated clinical practice owing to reports of a high frequency of incarceration and significant complications associated with untreated inguinal hernias. We aim to evaluate the frequency of complications after discharge with delayed surgery for inguinal hernia repair. MethodsThe Nationwide Readmissions Database (2010–2014) was queried to identify infants diagnosed with inguinal hernia. We compared the frequency and characteristics of inguinal hernia repair performed during the index admission, discharge from the index admission without hernia repair, and unplanned readmissions. ResultsWe identified 33,530 infants (16,624 preterm and 16,906 full-term) diagnosed with an inguinal hernia during an index admission. For those infants diagnosed with an inguinal hernia at birth, inguinal hernia repair was performed during the birth admission for only a minority of both preterm (35%) and full-term infants (18%; P < .001). Of the infants discharged without hernia repair, 15% required nonelective readmission up to 1 year later, but only 2% of preterm and 1% of full-term infants actually underwent inguinal hernia repair during these unplanned readmissions. None of the readmitted infants underwent additional procedures suggestive of a strangulated hernia. ConclusionComplications among infants awaiting inguinal hernia repair may be substantially less common than previously reported, and the occurrence of significant associated morbidity is quite rare.

Economic assessment of starting robot-assisted laparoscopic inguinal hernia repair in a single-centre retrospective comparative study: the EASTER study.

BackgroundThere has been a rapid adoption of robot-assisted laparoscopic inguinal hernia repair in the USA, despite a lack of proven clinical advantage and higher material cost. No studies have been published regarding the cost and outcome of robotic inguinal hernia surgery in a European Union setting.MethodsA retrospective comparative study was performed on the early outcome and costs related to laparoscopic inguinal hernia repair, with either conventional or robot-assisted surgery.ResultsThe study analysed 676 patients undergoing laparoscopic inguinal hernia repair (272 conventional and 404 robotic repairs). Conventional laparoscopic and robotic repair groups were comparable in terms of duration of surgery (57.6 versus 56.2 min respectively; P = 0.224), intraoperative complication rate (1.1 versus 1.2 per cent; P = 0.990), in-hospital complication rate (4.4 versus 4.5 per cent; P = 0.230) and readmission rate (3.3 versus 1.2 per cent; P = 0.095). There was a significant difference in hospital stay in favour of the robotic approach (P = 0.014), with more patients treated on an outpatient basis in the robotic group (59.2 per cent versus 70.0 per cent for conventional repair). At 4-week follow-up, equal numbers of seromas or haematomas were recorded in the conventional laparoscopic and robotic groups (13.3 versus 15.7 per cent respectively; P = 0.431), but significantly more umbilical wound infections were seen in the conventional group (3.0 per cent versus 0 per cent in the robotic group; P = 0.001). Robotic inguinal hernia repair was significantly more expensive overall, with a mean cost of €2612 versus €1963 for the conventional laparoscopic approach (mean difference €649; P < 0.001).ConclusionRobot-assisted laparoscopic inguinal hernia repair was significantly more expensive than conventional laparoscopy. More patients were treated as outpatients in the robotic group. Postoperative complications were infrequent and mild.

Comparison of Bupivacaine and 2-Chloroprocaine with and without Fentanyl for Subarachnoid Block in Inguinal Hernia Repair Surgery: A Randomised Controlled Study

Introduction: Providing an adequate intraoperative anaesthesia with a prolonged pain-free interval is the prime priority of an anaesthesiologist. Since the decline in use of 2-chloroprocaine in 1956, due to side-effects of its preservative sodium bisulfite, the preservative free drug has recently witnessed a comeback in clinical practice. Aim: To compare the efficacy of bupivacaine and 2-chloroprocaine with and without fentanyl in subarachnoid block for inguinal hernia repair surgery. Materials and Methods: This randomised controlled study was carried out on 102 male patients of 18-65 years of age, American Society of Anesthesiologists (ASA) grade I or II, scheduled for inguinal hernia repair. The study was conducted from May 2019 to November 2020. The patients were randomly divided into three groups of 34 each. In group A, the subarachnoid block was administered with injection 0.5% bupivacaine (H) 10.5 mg. In group B, patients were administered, injection 2-chloroprocaine 40 mg diluted with 0.5 mL of saline. In group C, the patients were administered with injection 2-chloroprocaine 40 mg with 25 μg of injection fentanyl (0.5 mL). The adequacy of intraoperative anaesthesia in terms of onset and duration of sensory and motor blockade, haemodynamic parameters, postoperative urinary retention and other side-effects were evaluated. The parameters were compared using Analysis of variance test (&gt;2 groups). If statistically significant difference was found in ANOVA, appropriate post-hoc (LSD/Bonferroni) was used to assess statistical significance of pair-wise comparisons. Results: The mean time of onset of the motor and sensory block was faster in group B (3.57±0.66, 2.68±0.58 min), by almost 1 minute than in the bupivacaine and fentanyl group (4.57±0.79, 3.59±0.61 min) (4.99±1.01, 4.04±0.99 min) respectively. The mean difference was statistically significant (p-value &lt;0.05). The mean duration of the motor and sensory blocks between the groups revealed statistically significant difference between groups A and B as well as groups A and C. However, between groups B and C, there was no significant difference as far as motor block duration is concerned. Group B had significantly shorter duration of the motor and sensory block amongst the three groups. Conclusion: Addition of intrathecal fentanyl significantly prolonged the onset and duration of sensory and motor block, with minimally extending the time to complete recovery.

Effect of Preoperative Nursing Protocol on Pain and Daily Activities for Post Inguinal Hernia Repair Patients

Background: Pain is the most serious long-term complication occurring after inguinal hernia repair with negative effects on all daily activities. As teaching is considered an important part of nursing care, interventions aimed to reduce pain and improving daily activities following surgical inguinal hernia repair are critically needed. Aim of the study: Toinvestigate the effect of Preoperative nursing protocol on reducing pain and improving daily activities post inguinal hernia repair. Methodology: Research design: Quasi-experimental research design was utilized in the present study. Sample: A purposive sample of (60) male patients undergoing inguinal hernia repair surgery. Setting: The study was carried out at the general surgical unit of Qena University Hospital, Qena governorate, Egypt. Tools of data collection: Three tools were utilized to collect data, First Tool: Structured questionnaire covered 3 parts: First part: Demographic data of the patients. Second part: Medical profile of the patients. Third part: Included knowledge assessment sheet about inguinal hernia disease, pain-relieving strategies and, how to prevent inguinal hernia recurrence. Second Tool: Pain numerical rating scale. Third Tool: Physical self-maintenance scale (Activities of daily living). Study Duration: Data collection of this study was carried out through six months, from the beginning of December 2019 till the end of May 2020. Results: our results revealed that ages among the study and the control groups ranged between (51 to 60 years), with a mean age (51.7±9.42 years and 55.4±6.21 years) respectively. Also, the study group demonstrated low level of pain as compared to control group after application of nursing interventions with a statistical significant difference between the mean score of pain level among the study and the control groups whereas the 1st follow-up was (2.03±0.66 & 0.16±0.37) respectively, at the 2nd follow-up was (5.83±0.46 & 3.57±0.50) respectively, and at the 3rd follow-up was (5.97±0.183 & 5.53±0.507) respectively, moreover the mean score of daily living activities of the study group improved versus the control group with a statistical significant difference in which the 1st follow-up was (1.93+.691 & 0.23+0.43) respectively, at the 2nd follow-up was (5.33+0.661 & 3.6+0.563) respectively, and at the 3rd follow-up was (5.93+0.2454 & 5.53+0.507) respectively. Conclusion: application of preoperative nursing protocol reflected a significant effect on patient's outcomes among the study group as postoperative pain level declined and level of activities increased as compared to the control group. Recommendations: Educational classes with a guide booklet should be provided at regular intervals for patients undergoing hernia repair, and replication of the current study on a larger probability sample from different geographical areas to achieve generalizable results are recommended.

A rare finding from a colonoscopy and laparoscopy of a patient with mesenteric panniculitis mimicking cancerous peritonitis

A 75-year-old man presented with abdominal distention lasting for 2 weeks. During the preceding year, he underwent inguinal hernia repair surgery. Laboratory tests revealed serum tumor markers within normal limits, whereas his C-reactive protein level was increased (9.10 mg/dL). Computed tomography revealed ascites and fine reticular shadowing of the intestines, leading us to suspect cancerous peritonitis (A). A colonoscopy showed concentrated ridges with edematous thickening on the mesenteric side of the transverse colon (B).

Ultrasound-guided Ilioinguinal-Iliohypogastric nerve block in inguinal hernia repair surgery under general anesthesia: a randomized controlled study

Ultrasound-guided Ilioinguinal-Iliohypogastric nerve block in inguinal hernia repair surgery under general anesthesia: a randomized controlled study

Ultrasound-guided microwave ablation in the treatment of inguinal neuralgia.

Chronic groin pain can be due to a variety of causes and is the most common complication of inguinal hernia repair surgery. The etiology of pain after inguinal hernia repair surgery is often multifactorial though injury to or scarring around the nerves in the operative region, namely the ilioinguinal nerve, genital branch of the genitofemoral nerve, and the iliohypogastric nerve, is thought to be a key factor in causing chronic post-operative hernia pain or inguinal neuralgia. Inguinal neuralgia is difficult to treat and requires a multidisciplinary approach. Radiologists play a key role in the management of these patients by providing accurate image-guided injections to alleviate patient symptoms and identify the pain generator. Recently, ultrasound-guided microwave ablation has emerged as a safe technique, capable of providing durable pain relief in the majority of patients with this difficult to treat condition. The objectives of this paper are to review the complex nerve anatomy of the groin, discuss diagnostic ultrasound-guided nerve injection and patient selection for nerve ablation, and illustrate the microwave ablation technique used at our institution.

Opioid Use After Inguinal and Ventral Hernia Repair.

Recent data on opioid consumption indicate that patients typically require far less than is prescribed. Prisma Health Upstate Hernia Center adopted standardized postoperative prescribing after hernia repair and began tracking patient-reported opioid utilization. The aim of this study is to evaluate patient opioid use after hernia repair in order to guide future prescribing. All patients who underwent primary ventral (umbilical and epigastric), incisional, and inguinal hernia repair between February and May 2019 were reviewed. Patients reported the number of opioid pills taken at their first postoperative visit and documented either in the progress note or in the Americas Hernia Society Quality Collaborative (AHSQC) patient-reported outcomes (PRO) questionnaire. All demographic, operative, and outcomes data were captured prospectively in the AHSQC. Opioid use reported as milligram morphine equivalents (MME). A total of 162 surgeries were performed during the study period, and 107 had patient-reported opioid use for analysis. Inguinal hernia repair was performed in 36 patients, 10 primary ventral hernia repairs, and 61 incisional hernia repairs. No opioid use was reported in 63.9% of inguinal hernias, 60% of primary ventral hernias, and 20% of incisional hernias. Inguinal hernia patients consumed a mean of 10.5 MME, primary ventral patients 11 MME, and incisional hernia patients 78.5 MME. Patients require little to no opioid after primary ventral or inguinal hernia repair and opioid-free surgery is feasible. Incisional hernia is more heterogenous, but the majority of patients still required less opioid than previously thought.

Quadratus Lumborum Block As A Single Anesthetic Method For Laparoscopic Totally Extraperitoneal (Tep) Inguinal Hernia Repair: A Randomized Clinical Trial

Minimally invasive surgery for inguinal hernia repair is advantageous in terms of return to usual activities and lower rates of chronic pain; however, it requires general anesthesia. This study sought to analyze the benefits of ultrasound guided locoregional anesthesia of the quadratus lumborum muscle (QL block) as a single anesthetic technique for endoscopic totally extraperitoneal (TEP) inguinal hernia repair with regard to postoperative pain, length of hospital stay, and hospital cost. A total of 46 patients, aged 18 to 80 years, with unilateral inguinal hernia, one group that received general anesthesia and one that received sedation and QL block for TEP inguinal hernia repair. In the 46 patients the median pain score 6 hours after surgery was significantly lower (2 versus 4) among the QL block group than among the group receiving general anesthesia. Consequently, the former group showed a briefer median hospital stay (6 versus 24 hours, respectively). The anesthesia and hospital costs were also lower for the QL block group, with median reductions of 64.15% and 25%, respectively. QL block is a safe and effective option for patients undergoing TEP inguinal hernia repair, given the observed reduction in early postoperative pain, briefer hospital stay, and decreased anesthesia and hospital costs.

Comparison of Total Extraperitoneal Laparoscopic Surgery for Inguinal Hernia Repair between Elderly and Non-Elderly Patients

Introduction: With the increase in global life expectancy, more elderly patients are being treated in outpatient clinics of hospitals. Morbidity and mortality rates are higher in elderly patients than in non-elderly patients after laparoscopic surgery because of the high incidence of comorbidities, such as cardiac, pulmonary and renal disease, and decreased performance. The aim of this study was to compare the outcomes of total extraperitoneal laparoscopic surgery for inguinal hernia repair between elderly and non-elderly patients. Materials and Methods: Between March 2012 and January 2019, 210 patients underwent laparoscopy for inguinal hernia repair. Patients were categorised into two groups based on age: group 1 (＜ 65 years) and group 2 (≥ 65 years). Demographic data and surgical outcomes of patients were retrospectively analysed from hospital records. Results: In total, 108 (51.4%) patients in group 1 and 102 (48.6%) patients in group 2 with mean ages of 46.5 and 70.8 years, respectively, underwent surgery. Thirty six patients in group 1 and 102 patients in group 2 had comorbidities. The incidences of postoperative complications were eight (7.4%) and three (2.9%) in groups 1 and 2, respectively. The mean follow-up period was 28.4 and 26.7 months in groups 1 and 2, respectively. Although three cases of recurring hernia were identified in group 1, one was reported in group 2. Conclusion: Although morbidity and mortality are higher in elderly patients, laparoscopic inguinal hernia repair can be performed safely.

Inguinal Hernia Repair with Progrip ™ Mesh Under Local Anesthesia in High-Risk Elderly Patients

Background: Inguinal hernia repair surgery is one of the most common surgical procedures in the world. There are various types of this surgery, and emerging evidence suggests repair under local anesthesia using Parietex ProGrip mesh may be a favorable option for individuals who are elderly and high-risk. This study aimed to explore its reliability and efficacy in that demographic.Materials and Methods: The results of 160 patients who underwent inguinal hernia surgery using Parietex ProGrip mesh between January 2014 and March 2018 were retrospectively reviewed. Local anesthesia was administered by anesthesiology expert with using a mixture of 20 mg/ml lidocaine + 0.0125 mg / mL epinephrine, 2% prilocaine, 0.5% bupivacaine and saline. Preoperative ultrasonography was performed to assess the type of inguinal hernia, and Gilbert was the preferred classification method. The operative and mesh application times, postoperative recurrence of hernia and health status, along with follow-ups were statistically evaluated.Results: In the present study, 160 patients had a mean ± standard deviation (SD) age of 73.6 ± 3.4 y. Most were diagnosed with Gilbert type 2 (n = 42; 26.3%) and type 3 (n = 49; 30.6%) inguinal hernias; all were ASA Grade 3 (n = 83; 51.9%) or Grade 4 (n = 77; 48.1%). The mean ± SD operative and mesh application times were 30.0 ± 3.8 min and 1.18 ± 0.6 min, respectively. No anesthesia-related side effects or treatment-related mortalities were observed. No readmission, systemic complication, postoperative recurrence or death occurred during the 6-month follow-up period. Postoperative seroma was observed in 6 patients and confirmed by a radiologist via ultrasonography. The pain visual analog scale (VAS) score decreased significantly and the health VAS score increased significantly over time (p=0.0001 for both).Conclusions: Open inguinal hernia surgery performed using a self-adhesive Parietex ProGrip mesh under local anesthesia is a safe and effective treatment option for high-risk elderly patients.

The effect of dexmedetomidine on spinal anesthesia quality and hemodynamic changes in patients undergoing inguinal hernia repair surgery: intravenous versus intrathecal.

The aim of this study was to evaluate the quality of spinal anesthesia and hemodynamic parameters of intravenous versus intrathecal dexmedetomidine in patients undergoing inguinal hernia repair surgery under spinal anesthesia. Fifty male patients aged 18-70years with ASA I and II were randomly divided into two groups of 25 patients receiving either intravenous (1μg/kg infused during 10min before blockade) or intrathecal (5μg, added to local anesthetics) dexmedetomidine. The duration of analgesia, sensory and motor blockade levels, the score of pain intensity, post-operative analgesic usage and the level of sedation as well as hemodynamic changes, and complications were recorded. The duration of analgesia in the intrathecal group was significantly longer than intravenous group (403.588 ± 93.706 vs. 274.048 ± 47.266min; P < 0.001). Duration of the sensory and motor blockade were significantly longer in intrathecal than intravenous group (230.440 ± 26.494 vs. 181.400 ± 28.850min; P < 0.001 for sensory block, and 253.800 ± 32.637 vs. 205.400 ± 30.921min; P < 0.001 for motor block). The score of pain intensity was lower in the intrathecal group in the post-operative period (3.680 ± 1.680 vs. 5.520 ± 1.901; P = 0.001 and 2.360 ± 1.320 vs. 3.24 ± 1.69; P = 0.041, respectively, for the time 6 and 12). Ramsay sedation score was higher in the intravenous group during surgery but it was higher in intrathecal group during recovery room period (P < 0.05). Moreover, the incidence of bradycardia was significantly lower in the intrathecal group (0% vs. 36% respectively; P = 0.002). Administration of intrathecal dexmedetomidine along with local anesthetics can be recommended to increase the quality of spinal anesthesia with minimal complications.

Antibiotic prophylaxis for prevention of postoperative wound infection in adults undergoing open elective inguinal or femoral hernia repair.

Inguinal or femoral hernia is a tissue protrusion in the groin region and has a cumulative incidence of 27% in adult men and of 3% in adult women. As most hernias become symptomatic over time, groin hernia repair is one of the most frequently performed surgical procedures worldwide. This type of surgery is considered 'clean' surgery with wound infection rates expected to be lower than 5%. For clean surgical procedures, antibiotic prophylaxis is not generally recommended. However after the introduction of mesh-based hernia repair and the publication of studies that have high wound infection rates the debate as to whether antibiotic prophylaxis is required to prevent postoperative wound infections started again. To determine the effectiveness of antibiotic prophylaxis in reducing postoperative (superficial and deep) wound infections in elective open inguinal and femoral hernia repair. We searched several electronic databases: Cochrane Registry of Studies Online, MEDLINE Ovid, Embase Ovid, Scopus and Science Citation Index (search performed on 12 November 2019). We also searched two trial registers and the reference list of included studies. We included randomised controlled trials comparing any type of antibiotic prophylaxis versus placebo or no treatment for preventing postoperative wound infections in adults undergoing inguinal or femoral open hernia repair surgery (tissue repair and mesh repair). Two review authors independently selected studies, extracted data and assessed risk of bias. We separately analysed results for two different surgical methods (herniorrhaphy and hernioplasty). Several studies revealed infection rates that were higher than the expected 5% for clean surgery and we therefore divided studies into two subgroups: high infection risk environments (≥ 5% infection rate); and low infection risk environments (< 5% infection rate). We performed meta-analyses with random-effects models. We analysed three outcomes: superficial surgical site infections (SSSI); deep surgical site infections (DSSI); and all postoperative wound infections (SSSI + DSSI). In this review update we identified and included 10 new studies. In total, we included 27 studies with 8308 participants in this review. It is uncertain whether antibiotic prophylaxis as compared to placebo (or no treatment) prevents all types of postoperative wound infections after herniorrhaphy surgery (risk ratio (RR) 0.86, 95% confidence interval (CI) 0.56 to 1.33; 5 studies, 1865 participants; very low quality evidence). Subgroup analysis did not change these results. We could not perform meta-analyses for SSSI or DSSI as these outcomes were not reported separately. Twenty-two studies related to hernioplasty surgery (total of 6443 participants) and we analysed three outcomes: SSSI; DSSI; SSSI + DSSI. Within the low infection risk environment subgroup, antibiotic prophylaxis as compared to placebo probably makes little or no difference for the outcomes 'prevention of all wound infections' (RR 0.71, 95% CI 0.44 to 1.14; moderate-quality evidence) and 'prevention of SSSI' (RR 0.71, 95% CI 0.44 to 1.17, moderate-quality evidence). Within the high infection risk environment subgroup it is uncertain whether antibiotic prophylaxis reduces all types of wound infections (RR 0.58, 95% CI 0.43 to 0.77, very low quality evidence) or SSSI (RR 0.56, 95% CI 0.41 to 0.77, very low quality evidence). When combining participants from both subgroups, antibiotic prophylaxis as compared to placebo probably reduces the risk of all types of wound infections (RR 0.61, 95% CI 0.48 to 0.78) and SSSI (RR 0.60, 95% CI 0.46 to 0.78; moderate-quality evidence). Antibiotic prophylaxis as compared to placebo probably makes little or no difference in reducing the risk of postoperative DSSI (RR 0.65, 95% CI 0.26 to 1.65; moderate-quality evidence), both in a low infection risk environment (RR 0.67, 95% CI 0.11 to 4.13; moderate-quality evidence) and in the high infection risk environment (RR 0.64, 95% CI 0.22 to 1.89; low-quality evidence). Evidence of very low quality shows that it is uncertain whether antibiotic prophylaxis reduces the risk of postoperative wound infections after herniorrhaphy surgery. Evidence of moderate quality shows that antibiotic prophylaxis probably makes little or no difference in preventing wound infections (i.e. all wound infections, SSSI or DSSI) after hernioplasty surgery in a low infection risk environment. Evidence of low quality shows that antibiotic prophylaxis in a high-risk environment may reduce the risk of all wound infections and SSSI, while evidence of very low quality shows that it is uncertain whether antibiotic prophylaxis reduces DSSI after hernioplasty surgery.

Continuation of antithrombotic therapy increases minor bleeding but does not increase the risk other morbidities in open inguinal hernia repair: A propensity score-matched analysis.

An aging population has led to an increased number of patients with cardiovascular comorbidities requiring antithrombotic therapy. Perioperatively, surgeons should consider the increased risk of bleeding and thrombotic events in patients continuing or discontinuing these medications. We aimed to analyze the safety of continued antithrombotic therapy during open inguinal hernia repair. In this single-center, retrospective study, 4870 adult patients who underwent open inguinal hernia repair surgery by the same surgeon from 2008 January to 2019 March were included. Patients who underwent surgery while continuing antithrombotic therapy were included in the antithrombin group (n = 523) while those who were not under any antithrombotic therapy during the surgery were included in the control group (n = 4333). Using propensity score-matching, we then selected patients from each group with similar backgrounds. Surgery time, anesthesia time, postoperative bleeding, reoperation, and thrombotic event data were compared between the groups. Subgroup analysis based on the type of medications used was performed within the antithrombin group. Ten patients in the antithrombin group and seven patients in the control group experienced postoperative bleeding (p < 0.001). The rate of postoperative bleeding was the highest in patients taking multiple medications. However, most were managed conservatively. Three patients from the antithrombin group experienced thrombotic events postoperatively (p = 0.001). Patients receiving continued antithrombotic therapy had an increased risk of minor postoperative bleeding; however, they are a high-risk group for thrombotic events.

AB094. Mesh crisis in inguinal hernia repair? Reliability &amp; quality assessment of current internet information

Background: Mesh-related complications following pelvic prolapse surgery has potentiated societal fear and investigation into mesh use in inguinal hernia repair (IHR) surgery. However concern exists regarding the quality of Internet health informatics. The DISCERN Instrument and HONcode are recommended to assess the quality and reliability of health information online. The aim of this study is to investigate the reliability and quality of online information pertaining to mesh use in IHR surgery.

Risk and protective factors for chronic pain following inguinal hernia repair: a retrospective study.

A large proportion of patients experience chronic post-surgical pain (CPSP) following inguinal hernia repair surgery. The aim of this study was to investigate the predictive risk factors and protective factors for CPSP following inguinal hernia surgery. After institutional ethics approval was obtained, we conducted a retrospective observational case-control study including a total of 236 adult patients undergoing electiveinguinal hernia repair at a single tertiary medical center from 2014 to 2015. Preoperative and postoperative variables were collected from electronic medical records. Binary logistic analysis was used to determine the association between CPSP and clinical factors and built a CPSP risk model. The incidence of CPSP was 14.4%. Bilateral inguinal hernia repair (OR 4.44; 95% CI 1.62 to 12.17; p = 0.004), preoperative pain (OR 2.57; 95% CI 1.14 to 5.79; p = 0.023), preoperative anxiety (OR 1.05; 95% CI 1.01 to 1.09; p = 0.018), and relatively high intensity of acute pain at 1week after the surgery (OR 1.40; 95% CI 1.03 to 1.91; p = 0.031) were the risk factors for CPSP while low-dose ketamine at anesthesia induction (OR 0.42; 95% CI 0.18 to 0.98; p = 0.044) was the protective factor for CPSP in patients undergoing inguinal hernia repair. These results indicated that bilateral inguinal hernia repair, preoperative pain, preoperative anxiety, and acute pain at 1week after the surgery were the independent risk factors for CPSP while low-dose ketamine was the protective factor. These findings may assist with primary prevention by allowing clinicians to screen for individuals with the risk of CPSP.

Preprocedural Ultrasound Estimates of Epidural Depth: Transverse Median Plane is Comparable to Paramedian Sagittal Oblique Plane in Non-Pregnant Patients

ObjectiveThe aim of this study was to assess the accuracy and precision of the actual epidural depth (ND) and ultrasound (US) estimates of the distance from the skin to the epidural space in the transverse median plane (ED/TM) and paramedian sagittal oblique plane (ED/PSO) in patients who were not pregnant and who were undergoing unilateral inguinal hernia repair surgery under combined spinal epidural anaesthesia.MethodsA total of 100 patients with the American Society of Anaesthesiology status I–III of either gender were recruited. All epidurals were inserted at the L3–4 intervertebral space, and the epidural needle was marked with a sterile marker. The ND was measured between the marker and the tip of the needle. The ED/TM and ED/PSO were assessed with a 2–5 MHz curved array probe at the L3–4 intervertebral space. The Pearson correlation coefficient and Lin’s concordance correlation coefficient were used to assess the precision and the Bland–Altman test was used to assess the 95% limit of agreement.ResultsThe ND was 48.98±6.91 mm, the ED/PSO was 48.92±6.91 mm and the ED/TM was 48.90±6.91 mm. The Pearson correlation coefficient between ND and ED/PSO was 0.995 (p<0.001) and 0.994 (p<0.001) with ED/TM. Lin’s concordance correlation coefficient for ND and ED/PSO was 0.995 (95%CI [confidence interval]: 0.992–0.997), and 0.993 for ND and ED/TM (95% CI: 0.990–0.996). The 95% limit of agreement between ND and ED/PSO was 0.70–1.37, and for ND and ED/TM, it was 0.79–1.54.ConclusionPreprocedural ultrasound (US) scanning in both planes provides reliable estimates for actual epidural depth in non-pregnant patient population.

Comparison of quadratus lumborum block and caudal block for postoperative analgesia in pediatric patients undergoing inguinal hernia repair and orchiopexy surgeries: a randomized controlled trial

Background and objectivesCaudal epidural anesthesia is a widely used popular technique for postoperative analgesia but it has potential side effects and duration of analgesia is short. Quadratus lumborum block (QLB)...

EVALUATION OF TRANSVERSUS ABDOMINIS PLANE (TAP) BLOCK WITH INJ.BUPIVACAINE 0.25% FOR POST-OPERATIVE ANALGESIA IN INGUINAL HERNIA REPAIR SURGERY

Background: TransversusAbdominis Plane(TAP)Block is a regional analgesictechnique. It provides postoperative analgesia after lower abdominal surgery. The purpose of our study was to evaluate effectiveness of TAP block to provide effective postoperative analgesia in patients undergoing inguinal hernia repair surgery. Method: Total 60 patients undergoing inguinal hernia surgery were randomized toundergo TAP block with bupivacaine (n = 30) versus normal saline (n = 30)control group. All patients received a standard spinal anaesthesia with standardmonitoring. A TAP block was performed using 20 ml 0.25% bupivacaine on the side ofsurgery or 20 ml saline at the end of surgery. Each patient was followed uppostoperatively at 0, 30 min, 60 min, 2 hr, 4, 6, 8, 12, 18 and 24 hours in PACU. Rescue analgesics inj. Diclofenacwere offered to any patient whocomplained of pain (VAS Score ≥4). Time of rescueanalgesia, total analgesic consumption and any other complications wereassessed. Result : There was a significantly longer time to the first request for rescue analgesic in bupivacaine group. (507.77 ± 10.38 min) compared to NS group.(110.87±14.2min) Total diclofenacconsumptionwas significantly higher in Group S than Group B (82.75 ± 23.2 mg vs193.97 ± 37.6 mg). Conclusion : TAP block provides better postoperative analgesia in patient undergoing inguinalhernia repair surgery . It prolongs the duration of postoperative analgesia and significantly reduces the total analgesic consumption up to 24 hrs postoperatively

Analgesic sparing effect of dexamethasone with levobupivacaine in quadratus lumborum block in patients undergoing unilateral inguinal hernia repair: A prospective randomised controlled trial.

Background:Quadratus lumborum block (QLB) provides somatic and visceral analgesia to the lower thoracic and abdominal wall. The aim was to investigate the analgesic effect of dexamethasone with levobupivacaine in QLB in patients undergoing unilateral inguinal hernia repair surgery.Methods:A total of 90 patients of American Society of Anaesthesiologists (ASA) I/II were randomly divided into two groups. Group L received 0.25% levobupivacaine (20 ml) + normal saline (1 ml) and group D received 0.25% levobupivacaine (20 ml) + 4 mg dexamethasone (1 ml) in QL plane on the operated side using ultrasound, after completion of surgery under spinal anaesthesia. The primary objective was to compare time for first rescue analgesia. The secondary objectives were total rescue analgesic consumption and numeric rating scale (NRS) in the first 24 h.Results:The demographic data age, sex, height, weight and ASA were comparable in both groups. The mean time to request for first rescue analgesia was longer in group D compared to group L (1016.02 ± 205.97 min versus 640 ± 132.96 min; P < 0.0001). The mean total tramadol consumption in the first 24 h was lower in group D compared to group L (233.55 ± 86.92 mg versus 328.22 ± 78.74 mg; P < 0.0001). Patients in group D had significantly lower NRS scores at rest and on movement as compared to group L.Conclusions:The addition of dexamethasone to levobupivacaine in QLB results in prolonged duration of postoperative analgesia, less rescue analgesic requirements and better quality of analgesia as compared to levobupivacaine in unilateral inguinal hernia repair surgery.